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Hyperglycemia Management in the Hospital Tools to Make the Journey Safer & More Comfortable Bruce W. Bode, MD, FACE Atlanta Diabetes Associates Member of the SIG of GHA for Diabetes

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Objectives l Understand the need for protocols for managing hyperglycemia and diabetes in the hospital l Present what the Georgia Hospital Association (GHA) has done to date and what tools we are using to accomplish this task

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GHA Special Interest Group for Diabetes l Formed in 2003 with the mission to monitor, evaluate and enhance diabetes care in the state of Georgia l Team composed of over 50 medical specialists with interest in diabetes care in the hospital l Team members are MDs, RNs, RDs, PharmDs, Administrators, Insurance Reps, etc

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1 Center Experience with Glucommander over a 1 year period (2004 to 2005) l East Carolina University – 750 bed hospital with 7 ICUs l Glucommander initiated in all ICU patients with BG >140 mg/dL l 7 FTEs hired to implement the program l Average BG went from 167 to 126 mg/dl l LOS decreased in ICU by 1 day; in Hospital by 0.3 days l No central line infections l Net savings to hospital 2 million dollars (470% Return on Investment) Personal Communication with Chris Newton, MD FACE

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Current Status Of Glucommander l Being studied in 8 hospitals vs Hirsh et al drip l Discussions are on going with several groups to bring the device to all interested hospitals l Available for research purposes via www.glucommander.com

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Converting to SC insulin l If More than 0.5 u/hr IV insulin required with normal BG, start long-acting insulin (glargine) Exception: if no prior DM and normal A1C, may not need SC insulin Exception: if no prior DM and normal A1C, may not need SC insulin l Must start SC insulin at least 1 to 2 hours before stopping IV insulin l Some centers start long-acting insulin on initiation of IV insulin or the night before stopping the drip

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Correction Bolus (Supplement) l Must determine how much glucose is lowered by 1 unit of rapid-acting insulin l This number is known as the correction factor (CF) l Use the 1700 rule or Weight to estimate the CF l CF = 1700 divided by the total daily dose (TDD) [ex: if TDD = 50 units, then CF = 1700/50 = ~30 meaning 1 unit will lower the BG ~30 mg/dl ] l CF = 3000 divided by Weight in kg

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Hospital Diabetes Plan What Can We Do For Patients Admitted To Hospital? l Get Diabetes Education Consult l Instruct Patient in Monitoring and Recording See That Patient Has Meter on Discharge l Decide on Case Specific Program for Discharge l Arrange Early F/U with PCP

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Conclusion l Our journey is not over, it has only begun l We must normalize glucose in all hospital patients l By implementing, assessing and revising protocols/pathways for hyperglycemic management, we can achieve this ultimate goal of normal glycemia